HomeMy WebLinkAbout05-22-12INHERITANCE TAX Pennsylvania ` ~'
BUREAU OF INDIVIDUAL TAXES ~~~'i i~ R ;CDI~ ADJUSTMENT
INHERITANCE TAX DIVISION ~-~' -~ ~` %-» DEPARTMENT OF REVENUE
Po Box z9a6o1 ' ~ -BENEF•~D,I~ARY FORM ASSETS REV-1604A EX AFP (12-I1?
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HARRISBURG PA 17129-0 601 "~'-`''° '- - ~ -
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MARY E DIENER ~~~L~UE~~Ila~iC~ Cll., ~~
17801 LAFAYETTE DRIVE
OLNEY MD 20832-0000
DATE 05-08-2012
ESTATE OF TURNBAUGH VIOLET M
DATE OF DEATH 12-18-2010
FILE NUMBER 21 11-0280
COUNTY CUMBERLAND
SSN/DC 185-01-1563
ACN 11500121
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS !''~-
REV-1b04A EX AFP (12-11~
** INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS **
DATE: 05-08-2012
ESTATE OF: TURNBAUGH VIOLET M DATE OF DEATH: 12-18-2010 COUNTY: CUMBERLAND
FILE N0.:21 11-0280 S.S/D.C. NO.: 185-01-1563 ACN: 11500121
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: EDWARD JONES
TYPE OF ACCOUNT: CJO SECURITIES ( ) SEC ACCT C ) STOCK
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Due
Tax Rate
TAX CREDITS:
00
X 0.000
.00
- .00
.00
X .045
.00
ACCOUNT NO.: 957-12004
C ) BOND
NOTE: TO ENSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE I5 REFLECTED AS
A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
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